Background: Delivering PrEP to adolescent girls and young women (AGYW) through maternal and child health (MCH) and family planning (FP) clinics in Africa may substantially reduce HIV acquisition in this population. Evaluation of implementation challenges and strategies within health systems are critical to inform future scale-up.
Methods: We conducted focus group discussions (FGDs) with healthcare workers (HCWs) offering PrEP in MCH and FP clinics as part of the PrEP Implementation for Young Women and Adolescents (PrIYA) Program in Kisumu, Kenya. Topic guides were based on the Consolidated Framework for Implementation Research (CFIR). An analysis of FGD audio and debrief reports was conducted to identify implementation challenges and employed strategies.
Results: Overall, 50 HCWs from 26 facilities participated in 8 FGDs. HCWs felt that PrEP met the needs of AGYW by providing a female controlled prevention strategy, and aligned with policy priorities of elimination of mother-to-child HIV transmission. They were universally enthusiastic about PrEP provision to AGYW through MCH clinics, noting the relative advantage of this approach because it:
1) enabled high coverage,
2) harmonized PrEP and MCH visits, and
3) lowered stigma compared to PrEP offered through HIV care clinics.
HCWs noted implementation challenges including:
1) increased workload and documentation burden amid healthcare workforce shortages,
2) physical space constraints,
3) drug and paperwork stockouts,
4) multiple implementing partners with different PrEP priorities and documentation practices at the same site, and
5) increased HIV testing sessions.
HCWs employed various implementation strategies to overcome implementation challenges, including task shifting from nurses to HIV Testing Service (HTS) providers, facility-specific patient flow modifications (including fast-tracking PrEP clients to reduce wait times), PrEP demand-generation and myth-busting during health talks, provider education, dedicated PrEP delivery rooms, and coordination with adolescent friendly services. Additional suggested strategies to improve PrEP integration included community education to increase broader PrEP awareness and enable shorter counseling sessions, and task-shifting data entry and client risk assessments.
Conclusions: HCWs were enthusiastic about the feasibility, acceptability, and potential sustainability of integrating PrEP services into MCH and FP clinics. Challenges and strategies focused on overcoming provider time and space constraints, and addressing provider and client knowledge.